| NPI | 1558760447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT012763) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006812) |
| 225100000X Physical Therapist (Licence: TN 10067) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2017-01-30 |